Lab analysis to measure the amylase (enzyme) level in serum specimen [HCPCS 82150]

Laboratory testing for amylase may be performed on blood, urine, and other body fluids. Amylase is an enzyme responsible for the break down of starches into sugar molecules (disaccharides and trisaccharides) and eventually into glucose for energy use by the cells. Amylase is produced in saliva and the pancreas. Abnormal amylase levels may result from pancreatic inflammation or trauma, perforated peptic ulcer, ovarian cyst (torsion), strangulation ileus, macroamylasemia, mumps, and cystic fibrosis. A blood or body fluid sample is obtained. The sample is then tested using quantitative enzymatic methodology.

Lab analysis of blood culture to identify bacteria [HCPCS 87040]

A blood sample is drawn and placed in a medium conducive to the growth of bacteria. Any bacteria present in the blood sample will then reveal themselves.

Lab analysis of urine culture to measure the amount of bacteria [HCPCS 87086]

"A laboratory test is performed to determine the presence or absence of bacterial colonies in urine and provide a colony count. Bacteria in urine may indicate an acute or chronic urinary tract infection (UTI) including pyelonephritis, cystitis, urethritis, or acute urethral syndrome. A urine sample is obtained by clean catch, mid-stream void or catheterization. Using a calibrated loop, the urine specimen is inoculated onto agar plates and incubated. Quantitative colony counts are determined and potential pathogens are identified. A colony count 10,000 cfu/mL is reported as ""organism present"" and may indicate an infection. Comingled flora of the urethra and mixed organisms in the colony counts are reported as ""mixed flora"" and most often represent contamination."

Lab analysis of any culture (except blood) to identify aerobic isolates (each isolate) [HCPCS 87077]

Used if further testing is required from an anaerobic bacterial tissue culture in order to verify the results.

Lab analysis of any culture (except urine, blood, or stool) to identify bacteria [HCPCS 87070]

A tissue sample besides blood, urine, or stool is collected and placed in a medium conducive to the growth of bacteria. The culture is examined for the growth of bacteria.

Lab analysis of urine culture to identify bacteria [HCPCS 87088]

Lab analysis to measure the creatinine level in blood specimen to test for kidney function or muscle injury [HCPCS 82565]

A blood sample is taken to measure creatinine levels. Creatinine is a waste product produced by the muscles in the breakdown of creatine, which is a compound used by the muscles to create energy for contraction. The waste product, creatinine, is excreted by the kidneys and blood levels provide a good measurement of renal function. Creatinine may be checked to screen for or monitor treatment of renal disease. Creatinine levels may also be monitored in patients with acute or chronic illnesses that may impair renal function and in patients on medications that affect renal function. Creatinine is measured using spectrophotometry.

Lab analysis to measure the blood potassium level in blood specimen [HCPCS 84132]

A blood sample is obtained to measure potassium level. Potassium is a positively charged electrolyte that works in conjunction with other electrolytes, such as sodium, chloride, and carbon dioxide (CO2), to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance. Potassium is found in all body fluids but mostly stored within cells, not in extracellular fluids, blood serum, or plasma. Small fluctuations in blood potassium, either too high (hyperkalemia) or too low (hypokalemia), can have serious, even life-threatening, consequences. Potassium level is used to screen for and monitor renal disease; monitor patients on certain medications, such as diuretics, as well as patients with acute and chronic conditions, such as dehydration or endocrine disorders. Because blood potassium affects heart rhythm and respiratory rate, it is routinely checked prior to major surgical procedures. Potassium is measured by ion-selective electrode (ISE) methodology.

Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]

A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.

Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]

Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.

Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]

A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.

Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]

"A lipid panel is obtained to assess the risk for cardiovascular disease and to monitor appropriate treatment. Lipids are comprised of cholesterol, protein, and triglycerides. They are stored in cells and circulate in the blood. Lipids are important for cell health and as an energy source. A lipid panel should include a measurement of triglycerides and total serum cholesterol and then calculate to find the measurement of high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C). HDL contains the highest ratio of cholesterol and is often referred to as ""good cholesterol"" because it is capable of transporting excess cholesterol in the blood to the liver for removal. LDL contains the highest ratio of protein and is considered ""bad cholesterol"" because it transports and deposits cholesterol in the walls of blood vessels. VLDL contains the highest ratio of triglycerides and high levels are also considered ""bad"" because it converts to LDL after depositing triglyceride molecules in the walls of blood vessels. A blood sample is obtained by separately reportable venipuncture or finger stick. Serum/plasma is tested using quantitative enzymatic method."

Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]

A blood test is performed to determine levels of thyroid stimulating hormone (TSH). TSH is produced in the pituitary and helps to regulate two other thyroid hormones, triiodothyronine (T3) and thyroxin (T4), which in turn help regulate the body's metabolic processes. TSH levels are tested to determine whether the thyroid is functioning properly. Patients with symptoms of weight gain, tiredness, dry skin, constipation, or menstrual irregularities may have an underactive thyroid (hypothyroidism). Patients with symptoms of weight loss, rapid heart rate, nervousness, diarrhea, feeling of being too hot, or menstrual irregularities may have an overactive thyroid (hypothyroidism). TSH levels are also periodically tested in individuals on thyroid medications. The test is performed by electrochemiluminescent immunoassay.

Lab blood analysis to confirm blood unit compatibility by antiglobulin technique [HCPCS 86922]

Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]

This test may also be referred to as an activated PTT or aPTT. PTT may be performed to diagnose the cause of bleeding or as a screening test prior to surgery to rule-out coagulation defects. A silica and synthetic phospholipid PTT reagent is mixed with the patient plasma. The silica provides a negatively-charged particulate surface that activates the contact pathway for coagulation. Clot formation is initiated by adding calcium chloride to the mixture. Clotting time is measured photo-optically.

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Lab analysis to measure the total creatine kinase (cardiac enzyme) level in blood specimen [HCPCS 82550]

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. A blood test is performed to measure total creatine kinase (CK) levels. A blood specimen is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.

Lab analysis to measure the creatinine level to test for kidney function or muscle injury (other than blood specimen) [HCPCS 82570]

A sample other than blood is taken to measure creatinine levels. Creatinine is a waste product produced by the muscles in the breakdown of creatine, which is a compound used by the muscles to create energy for contraction. The waste product, creatinine, is excreted by the kidneys and blood levels provide a good measurement of renal function. Creatinine may be checked to screen for or monitor treatment of renal disease. Creatinine levels may also be monitored in patients with acute or chronic illnesses that may impair renal function and in patients on medications that affect renal function. Creatinine clearance, also known as urea or urea nitrogen clearance tests both blood and urine samples for a calculation of creatinine content adjusted for urine volume and physical size as a general indicator of glomerular filtration function.

Lab analysis to measure the cyanocobalamin (vitamin b-12) level [HCPCS 82607]

Cyanocobalamin is a vitamer of the B-12 vitamin family and plays an important role in metabolism, red blood cell production and nervous system function. Blood levels of cyanocobalamin are measured. Blood levels may be reduced with pernicious and other forms of anemia, and in individuals who follow a strict vegan diet, have chronic infections (such as HIV) and during pregnancy. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Lab analysis by immunoassay (ELISA) to identify clostridium difficile toxins (stool pathogen) [HCPCS 87324]

Lab analysis by immunoassay (ELISA) to identify infectious organism antigen (multiple-step method, each organism) [HCPCS 87449]

Lab analysis by nucleic acid (DNA or RNA) to identify multiple types of digestive tract pathogens (12-25 targets) [HCPCS 87507]

Lab analysis by nucleic acid (DNA or RNA) to identify multiple types of respiratory virus (12-25 targets) [HCPCS 87633]

Lab analysis to evaluate an antimicrobial drug (antibiotic, antifungal, antiviral) by microdilution or agar dilution (each multi-antimicrobial, per plate) [HCPCS 87186]

A study is performed to determine the effectiveness of a specific antibiotic agent to a specific bacteria. The test is performed in an agar solution.

Lab analysis to measure the ferritin (blood protein) level [HCPCS 82728]

A blood test is performed to measure ferritin levels. Ferritin is an intracellular protein that stores iron and releases it into circulation in a controlled manner to protect the body against iron overload and iron deficiency. Ferritin levels may be obtained to evaluate for elevated levels caused by excess storage diseases such as hemochromatosis and following multiple transfusions. Levels may also be obtained to evaluate for decreased levels due to iron deficiency. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Lab analysis to measure the folic acid level in serum specimen [HCPCS 82746]

A blood test is performed to measure folic acid (folate) levels in serum or red blood cells (RBC). Folic acid (folate) may also be referred to as Vitamin B9 and is essential for the growth, division and repair of cells, especially fetal growth during pregnancy and in early infancy. It is also necessary for the production of healthy red blood cells and to prevent anemia at all ages. The test may be used to diagnose anemia or certain neuropathies and to monitor the effectiveness of treatment for these conditions. A blood sample is obtained by separately reportable venipuncture.

Lab analysis to measure the hemoglobin A1C level in blood specimen [HCPCS 83036]

A blood test is performed to measure glycosylated hemoglobin (HbA1C) levels. Plasma glucose binds to hemoglobin and the HbA1C test measures the average plasma glucose concentration over the life of red blood cells (approximately 90-120 days). HbA1C levels may be used as a diagnostic reference for patients with suspected diabetes mellitus (DM) and to monitor blood glucose control in patients with known DM. HbA1C levels should be monitored at least every 6 months in patients with DM and more frequently when the level is >7.0%. A blood sample is obtained by separately reportable venipuncture. Whole blood is tested using quantitative high performance liquid chromatography/boronate affinity.

Lab analysis to measure the iron binding capacity [HCPCS 83550]

A blood test is performed to measure the iron binding capacity of transferrin. Transferrin, a protein found in circulating blood is responsible for carrying iron molecules. This test measures the ability of transferrin to carry iron. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry/calculation.

Lab analysis to measure the iron level [HCPCS 83540]

A blood, urine or liver test is performed to measure iron levels. Iron (Fe) is an essential element that circulates in the blood attached to the protein transferrin. Iron is necessary component of hemoglobin, found in red blood cells (RBCs) and myoglobin found in muscle cells. Low iron levels may cause a decrease in red blood cells and iron deficiency anemia. High iron levels may be caused by excessive intake of iron supplements or a hereditary genetic condition such as hemochromatosis from a mutation of the RGMc gene or HAMP gene. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry. A random voided or 24 hour urine specimen is obtained and tested using quantitative inductively coupled plasma/emission spectrometry. Patient should wait 2-4 days after receiving iodine or gadolinium contrast media to collect a urine specimen. A liver sample is obtained by a separately reportable procedure. Liver tissue is tested using quantitative inductively coupled plasma-mass spectrometry.

Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]

A renal panel is obtained for routine health screening and to monitor conditions such as diabetes, renal disease, liver disease, nutritional disorders, thyroid and parathyroid function, and interventional drug therapies. Tests in a renal panel include glucose or blood sugar; electrolytes and minerals as sodium, potassium, chloride, total calcium, and phosphorus; the waste products blood urea nitrogen (BUN) and creatinine; a protein called albumin; and bicarbonate (carbon dioxide, CO2) responsible for acid base balance. Glucose is the main source of energy for the body and is regulated by insulin. High levels may indicate diabetes or impaired kidney function. Sodium is found primarily outside cells and maintains water balance in the tissues, as well as nerve and muscle function. Potassium is primarily found inside cells and affects heart rhythm, cell metabolism, and muscle function. Chloride moves freely in and out of cells to regulate fluid levels and help maintain electrical neutrality. Calcium is needed to support metabolic processes, heart and nerve function, muscle contraction, and blood clotting. Phosphorus is essential for energy production, nerve and muscle function, and bone growth. Blood urea nitrogen (BUN) and creatinine are waste products from tissue breakdown that circulate in the blood and are filtered out by the kidneys. Albumin, a protein made by the liver, helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bicarbonate (HCO3) may also be referred to as carbon dioxide (CO2) maintains body pH or the acid/base balance. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay or quantitative enzyme-linked immunosorbent assay.

Lab analysis to measure the lactic acid level in blood, plasma, or cerbrospinal fluid specimen [HCPCS 83605]

A blood or body fluid test is performed to measure lactate (lactic acid) levels. Lactic acid is produced primarily by muscle tissue and red blood cells in the body. Elevated levels may be caused by strenuous exercise, heart failure, severe infection (sepsis), shock states (cardiogenic, hypovolemic) and liver disease. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by lumbar puncture (spinal tap). Other body fluids may also be collected and tested. Plasma, CSF, and other body fluids are tested using enzymatic methodology.

Lab analysis to measure the lipase (fat enzyme) level [HCPCS 83690]

A test is performed on blood and body fluids to measure lipase levels. Lipase is an enzyme released by the pancreas into the small intestine and is essential for the digestion of dietary fats. Elevated levels may result from small bowel obstruction, celiac disease, cholecystitis, duodenal ulcer, severe gastroenteritis, macrolipasemia, pancreatitis, and pancreatic tumors. The test may be ordered when there is a family history of lipoprotein lipase deficiency. A blood sample is obtained by separately reportable venipuncture. Other body fluids collected by other methods. Blood and other body fluids are tested using quantitative enzymatic methodology.

Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 800

A hepatic function panel is obtained to diagnose acute and chronic liver disease, inflammation, or scarring and to monitor hepatic function while taking certain medications. Tests in a hepatic function panel should include albumin (ALB), total and direct bilirubin, alkaline phosphatase (ALP), total protein (TP), alanine aminotransferase (ALT, SGPT), and aspartate aminotransferase (AST, SGOT). Albumin (ALB) is a protein made by the liver that helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bilirubin, a waste product from the breakdown of red blood cells, is removed by the liver in a conjugated state. Bilirubin is measured as total (all the bilirubin circulating in the blood) and direct (the conjugated amount only) to determine how well the liver is performing. Alkaline phosphatase (ALP) is an enzyme produced by the liver and other organs of the body. In the liver, cells along the bile duct produce ALP. Blockage of these ducts can cause elevated levels of ALP, whereas cirrhosis, cancer, and toxic drugs will decrease ALP levels. Circulating blood proteins include albumin (60% of total) and globulins (40% of total). By measuring total protein (TP) and albumin (ALB), the albumin/globulin (A/G) ratio can be determined and monitored. TP may decrease with malnutrition, congestive heart failure, hepatic disease, and renal disease and increase with inflammation and dehydration. Alanine aminotransferase (ALT, SGPT) is an enzyme produced primarily in the liver and kidneys. In healthy individuals ALT is normally low. ALT is released when the liver is damaged, especially with exposure to toxic substances such as drugs and alcohol. Aspartate aminotransferase (AST, SGOT) is an enzyme produced by the liver, heart, kidneys, and muscles. In healthy individuals AST is normally low. An AST/ALT ratio is often performed to determine if elevated levels are due to liver injury or damage to the heart or skeletal muscles. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method or quantitative spectrophotometry.

Lab analysis to measure the magnesium level in body fluids and cells [HCPCS 83735]

A blood, urine, or fecal test is performed to measure magnesium levels. Magnesium is an essential dietary mineral responsible for enzyme function, energy production, and contraction and relaxation of muscle fibers. Decreased levels may result from severe burns, metabolic disorders, certain medications, and low blood calcium levels. A blood sample is obtained by separately reportable venipuncture. Red blood cells (RBCs) are tested using quantitative inductively coupled plasma-mass spectrometry. Serum/plasma is tested using quantitative spectrophotometry. A 24-hour voided urine specimen is tested using quantitative spectrophotometry. A random or 24-hour fecal sample is tested using quantitative spectrophotometry.

Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Lab analysis to measure the parathormone (parathyroid hormone) level [HCPCS 83970]

A blood or tissue test is performed to measure parathormone (parathyroid hormone, parathyrin) levels. Parathyroid hormone (PTH) is produced by chief cells in the parathyroid gland. The hormone helps to regulate blood calcium levels, absorption/excretion of phosphate by the kidneys and in Vitamin D synthesis in the body. Elevated levels (hyperparathyroidism) may be caused by parathyroid gland tumors or chronic renal failure. Decreased levels (hypoparathyroidism) may result from inadvertent removal (during thyroid gland surgery), autoimmune disorders or genetic inborn errors of metabolism. A blood sample is obtained by separately reportable venipuncture. Parathyroid gland tissue is obtained by separately reportable fine needle aspirate. Serum/plasma or tissue sample are tested using quantitative electrochemiluminescent immunoassay. Plasma is tested for parathyroid hormone, CAP (Cyclase Activating Parathyroid Hormone) using immunoradiometric assay.

Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]

Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. Total PSA is measured ad the total amount of both free and complexed forms. Total PSA levels are higher in men with benign prostatic hyperplasia (BPH), acute bacterial prostatitis, or prostate cancer. Total PSA is used to screen for prostate cancer and evaluate the response to treatment in those with prostate cancer, but cannot be used by itself to definitively diagnose prostate cancer.

Lab analysis to measure red blood cell sedimentation rate to detect inflammation (non-automated) [HCPCS 85651]

Lab test for Sedimentation rate

Lab analysis to screen for autoimmune disorders [HCPCS 86038]

A blood sample is obtained to screen for the presence of antinuclear antibodies (ANA) or to measure the concentration of antinuclear antibody in the blood, which is referred to as an ANA titer. Antinuclear antibodies are auto-antibodies that bind to structures within the nucleus of cells. Auto-antibodies are a type of antibody that is directed against the body's own tissues. The presence and concentration of antinuclear antibodies may indicate one of several autoimmune disorders that cause inflammation of body tissues including systemic lupus erythematosus, Sjorgren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison disease, vitiligo, pernicious anemia, glomerulonephritis, and pulmonary fibrosis. When testing for antinuclear antibodies, the specimen is typically screened first using an enzyme-linked immunosorbent assay (ELISA) If the screening test is positive, that is if antinuclear antibodies are detected, a titer is then obtained. An antinuclear antibody titer is performed by diluting the blood sample with increasing amounts of a saline solution and retesting until antinuclear antibodies are no longer detectable. ANA titer is expressed as 1:10, 1:20, 1:40, 1:80, etc, with the 1 indicating 1 part blood and the second number indicating the parts of saline solution. A higher second number indicates a higher concentration of antinuclear antibodies in the blood.

Lab analysis to screen for pathogenic organisms [HCPCS 87081]

This test is performed when a specific pathogen is suspected. A blood sample is taken and placed in a medium conducive to the growth of the suspected pathogen. Any colonies that grow in the medium are then examined.

Lab analysis to measure the amount of blood in stool specimen to screen for colon tumors [HCPCS 82270]

Lab test for Fecal Blood

Lab analysis to measure total testosterone (hormone) level in serum specimen [HCPCS 84403]

A urine test is performed to measure total testosterone level. Testosterone is an androgen hormone secreted in the testes of men, ovaries of women, and the adrenal glands of both sexes. Testosterone helps promote protein synthesis and supports the growth of cells and tissue. This test is often performed in conjunction with sex hormone binding globulin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma of adult males is tested using quantitative electrochemiluminescent immunoassay with the value derived from a mathematical expression using sex hormone binding globulin (SHBG). Serum/plasma of adult males may also be tested using quantitative equilibrium dialysis/high performance liquid chromatography-tandem mass spectrometry. Serum/plasma of children and adult females is tested using quantitative high performance liquid chromatography-tandem mass spectrometry/electrochemiluminescent immunoassay with the value also derived from a mathematical expression using sex hormone binding globulin (SHBG).

Lab analysis to measure the amount of free thyroid hormone, T3 in serum specimen [HCPCS 84481]

A blood sample is tested to determine levels of total triiodothyronine (T3), free T3, or reverse T3. T3 is a hormone made by the thyroid gland that affects almost every metabolic process including body temperature, growth, and heart rate. T3 can either be produced by the thyroid or synthesized by the body from T4. Approximately 95% of T3 is bound to proteins in the blood and is inactive. The remaining 5% is free and active. T3 tests are used to help determine whether the thyroid is functioning properly, to diagnose hyperthyroidism, and to monitor patients with known thyroid disorders. In total T3, which reflects the amount of both bound and free T3, is measured. Total and free T3 are evaluated using electrochemiluminescent immunoassay.

Lab analysis to measure free thyroxine (thyroid chemical) in serum specimen [HCPCS 84439]

A blood sample is obtained and levels of total thyroxin, thyroxine requiring elution as for testing in neonates or free thyroxine are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In free thyroxine levels are tested. Free thyroxine is the amount of active thyroxine in the blood. Free thyroxine levels are considered to be a more accurate indicator of thyroid function. All thyroxine tests use electrochemiluminescent immunoassay methodology.

Lab analysis to measure the amount of troponin (protein) in serum specimen [HCPCS 84484]

A blood test is performed to measure troponin levels. Troponins are regulatory proteins that facilitate contraction of skeletal and smooth muscle by forming calcium bonds. Troponin T binds to tropomyosin to form a complex. Troponin I binds to actin and holds the Troponin T-tropomyosin complex together. Elevation of troponins, coupled with cardiac symptoms such as chest pain are considered diagnostic for cardiac injury. This test is commonly ordered in the Emergency Department when a patient presents with possible myocardial infarction, and is then repeated at 6 hour intervals. It may be ordered with other tests that assess cardiac biomarkers such as CK, CK-MB, and myoglobin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested for Troponin T using quantitative electrochemiluminescent immunoassay. Serum is tested for Troponin I using chemiluminescent immunoassay.

Lab analysis to measure urea nitrogen level in serum or plasma specimen to assess kidney function (quantitative) [HCPCS 84520]

A blood sample is obtained to measure total (quantitative) urea nitrogen (BUN) level. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea then enters the bloodstream, is taken up by the kidneys and excreted in the urine. Blood BUN is measured to evaluate renal function, to monitor patients with renal disease, and to evaluate effectiveness of dialysis. BUN may also be measured in patients with acute or chronic illnesses that affect renal function. BUN is measured using spectrophotometry.

Lab analysis to measure the uric acid level in blood specimen [HCPCS 84550]

A blood test is performed to measure uric acid levels. Uric acid forms from the natural breakdown of body cells and the food we ingest. Uric acid is normally filtered by the kidneys and excreted in urine. Elevated blood levels may result from kidney disease, certain cancers and/or cancer therapies, hemolytic or sickle cell anemia, heart failure, cirrhosis, lead poisoning, and low levels of thyroid or parathyroid hormones. Levels may be decreased in Wilson's disease, poor dietary intake of protein, and with the use of certain drugs. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Lab analysis to measure the amount of vancomycin (antibiotic) in serum specimen [HCPCS 80202]

A blood test is performed to measure vancomycin levels at random, peak and trough times. Vancomycin, also known as Vancocin is a glycopeptide antibiotic prescribed to treat severe or serious bacterial infections. For systemic infections it is administered by intravenous infusion. For intestinal infections such as colitis or clostridium difficile it is taken orally. Blood level monitoring is necessary because the drug has the potential to cause auditory toxicity. A random sample may be drawn any time, peak and trough levels are time dependant and are usually drawn 24 hours after initiating therapy and every 2-3 days thereafter. A trough level is drawn 10 minutes prior to intravenous infusion. A peak level is drawn 1-2 hours after intravenous infusion is complete. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using fluorescence polarization immunoassay.

Lab analysis to measure the vitamin D-3 level in serum or plasma specimen [HCPCS 82306]

Blood levels of 25-hydroxyvitamin D are used to primarily to determine whether a deficiency of Vitamin D or abnormal metabolism of calcium is the cause of bone weakness or malformation. Vitamin D is a fat soluble vitamin that is absorbed from the intestine like fat, and 25-hydroxyvitamin D levels are also evaluated in individuals with conditions or diseases that interfere with fat absorption, such as cystic fibrosis, Crohn's disease, or in patients who have undergone gastric bypass surgery. A blood sample is obtained. Levels of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 are evaluated using chemiluminescent immunoassay. The test results may be the sum of Vitamin D3 and D2 or the results may include fractions of D3 and D2 as well as the sum of these values.

Semi-Private Room

Intensive Care Unit

Application of electrical stimulation with therapist present, each 15 minutes

Electrical stimulation involves the use of a transcutaneous electrical nerve stimulation device (TENS), functional electrical stimulation device (FES), or a neuromuscular electrical stimulation device (NMES). The physical therapist or other physical therapy aid places the electrodes of the selected device over the region to be stimulated. The electrical impulse is set to the desired strength and the control unit is turned on. Electrical impulses are transmitted to the skin. The electrical stimulation device causes the muscles to contract. The muscle contraction stimulates both muscle and nerve tissues to relieve pain and promote healing. Electrical stimulation may be provided as a supervised modality that does not require direct (one-on-one) patient contact or it may be provided under constant attendance with direct (one-on-one) patient contact.

Mechanical traction application to 1 or more areas [HCPCS 97012]

Emergency department visit for problem with significant threat to life [HCPCS 99285]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

Emergency department visit for problem of high severity [HCPCS 99284]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.

Emergency department visit for minor problem [HCPCS 99281]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

Emergency department visit for problem of low to moderate severity [HCPCS 99282]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

Emergency department visit for problem of moderate severity [HCPCS 99283]

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

Occupational therapy evaluation (typically 30 minutes) [HCPCS 97165]

An occupational therapy evaluation or re-evaluation is performed. Occupational therapy assists the patient in developing or regaining skills that allow independent functioning and enhance health and personal well-being. A patient history is taken that includes an occupational profile and medical and therapy history with review of records as well as an extensive review of physical, cognitive, or psychosocial elements related to current performance of daily activities. The occupational therapist evaluates the patient's physical functioning, mental, and/or neurobehavioral impairment and performs tests to identify functional limitations or performance deficits. Physical functioning is evaluated, including an evaluation of any musculoskeletal conditions that may impair function. The ability to perform basic activities of daily living such as dressing, bathing, mobility, and other activities for living independently, such as shopping, cooking, driving, or accessing public transportation are all assessed. Barriers in the home, school, work, and community environments are identified. The need for adaptive equipment is assessed. The occupational therapist develops a treatment plan using clinical decision making from the patient analysis, assessment data, comorbidities, and possible treatment options. During a re-evaluation, an interim history is taken; the patient's response to treatment is evaluated; and the plan of care is revised based on the patient's response to treatment, functional and medical status, and any changes in condition or environment that affect future interventions or goals.

Physical therapy evaluation (typically 20 minutes) [HCPCS 97161]

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Physical therapy evaluation (typically 30 minutes) [HCPCS 97162]

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Evaluation for physical therapy, typically 45 minutes

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Speech sound production evaluation with evaluation of language comprehension and expression [HCPCS 92523]

Disorders of speech sound production that relate to language comprehension and expression usually manifest before the age of 4 years. Mixed language disorder (receptive and expressive) may be due to brain injury, developmental problems such as autistic spectrum disorders, hearing loss and learning disorders. In receptive language disorders an individual will have problems understanding what has been said, following directions and organizing thoughts. Expressive language disorders can manifest with difficulty putting words together to form coherent sentences, word finding and the use of placeholder words such as ôumö, decreased vocabulary for age, leaving out words when speaking, improper use of tenses (past, present, future) and repetition (echoing) of phrases. Evaluation by a speech-language pathologist (SLP) should include an audiogram to assess hearing (reported separately), formal and informal observation and assessment using standardized testing tools such as Receptive-Expressive Emergent Language Test (REEL).

Swallowing function evaluation [HCPCS 92610]

An evaluation of the oral and pharyngeal phase of the swallowing function is performed in a patient who is suspected of having oropharyngeal dysphagia. The initial evaluation is typically performed by a dysphagia specialist, usually a speech-language pathologist. This evaluation is performed to determine whether more extensive studies are warranted. Swallowing function is divided into oral, pharyngeal, and esophageal phases. The oral and pharyngeal phases are made up of oral preparation for solid foods (not required for liquids or pureed foods), oral transfer, and initiation of the swallow. Both oral and pharyngeal movements are necessary in preparing, transferring, and swallowing food. The patient is given both solids and liquids to swallow. During oral preparation of solid food the ability of the tongue to move the food from side-to-side so that the solid can be chewed and prepared for swallowing is evaluated. Once the solid food is prepared and transferred to the back of the throat, the swallowing movements are evaluated. Propelling solids or liquids requires a complex set of movements including retraction of the base of the tongue, elevation of the hyolarynx, closure of the velopharyngeus, contraction of the pharynx, opening of the upper esophageal sphincter, and closure of the airway. The speech-language pathologist observes the patient to determine whether solids and liquids are being prepared, transferred, and propelled from the pharynx into the esophagus. A written report of findings is provided.

Hydration administration into vein by infusion (31 minutes to 1 hour) [HCPCS 96360]

An intravenous infusion is administered for hydration. An intravenous line is placed into a vein, usually in the arm, and fluid is administered to provide additional fluid levels and electrolytes to counteract the effects of dehydration or supplement deficient oral fluid intake. The physician provides direct supervision of the fluid administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Hydration administration into vein by infusion (each additional hour) [HCPCS 96361]

An intravenous infusion is administered for hydration. An intravenous line is placed into a vein, usually in the arm, and fluid is administered to provide additional fluid levels and electrolytes to counteract the effects of dehydration or supplement deficient oral fluid intake. The physician provides direct supervision of the fluid administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment. Use 96360 for the initial 31 minutes to one hour of hydration. Use 96361 for each additional hour.

Drug administration into vein by infusion for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96365]

An intravenous infusion of a specified substance or drug is administered for therapy, prophylaxis, or diagnosis. An intravenous line is placed into a vein, usually in the arm, and the specified substance or drug is administered. The physician provides direct supervision of the administration and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient's response to treatment.

Drug administration into vein by infusion for therapy, prevention, or diagnosis (each additional hour) [HCPCS 96366]

Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

Airway inhalation treatment to relieve airway obstruction or for sputum collection (inhaled pressure or nonpressure treatment) [HCPCS 94640]

The patient is placed on intermittent inhalation treatment for acute airway obstruction or to induce sputum production for therapeutic and/or diagnostic purposes. To treat acute airway obstruction, pressurized or nonpressurized bronchodilator medication is delivered for short intervals several times a day using an inhaler, nebulizer, aerosol generator, or an intermittent positive pressure breathing (IPPB) device. Bronchodilator medication is suspended as fine particles within a gaseous propellant and taken into the lungs as a fine spray. The medication acts to relax the smooth muscle of the bronchioles and lung tissue, which has constricted in conditions such as an asthma attack or hypersensitivity reaction, severely restricting air flow. The patient uses the prescribed pressurized or nonpressurized inhalation device as directed by the physician typically for 10-15 minutes several times during the day. To induce sputum production for diagnostic purposes, an isotonic or hypertonic solution is delivered using a nebulizer or other device. These solutions induct secretion of sputum in the lower airways. The patient must cough to expectorate the secretions which are collected in a sterile container and sent to the laboratory for separately reportable analysis.

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of new drug) [HCPCS 96375]

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Drug administration into vein by push technique for therapy, diagnosis, or prevention (initial drug) [HCPCS 96374]

A therapeutic, prophylactic, or diagnostic injection is administered by intravenous push (IVP) technique. The specified substance or drug is injected using a syringe directly into an injection site of an existing intravenous line or intermittent infusion set (saline lock). The injection is given over a short period of time, usually less than 15 minutes.

Drug administration beneath the skin or into muscle by injection for therapy, diagnosis, or prevention [HCPCS 96372]

A subcutaneous or intramuscular injection of a therapeutic, prophylactic, or diagnostic substance or drug is given. A subcutaneous injection is administered just under the skin in the fatty tissue of the abdomen, upper arm, upper leg, or buttocks. The skin is cleansed. A two-inch fold of skin is pinched between the thumb and forefinger. The needle is inserted completely under the skin at a 45 to 90 degree angle using a quick, sharp thrust. The plunger is retracted to check for blood. If blood is present, a new site is selected. If no blood is present, the medication is injected slowly into the tissue. The needle is withdrawn and mild pressure is applied. An intramuscular injection is administered in a similar fashion deep into muscle tissue, differing only in the sites of administration and the angle of needle insertion. Common sites include the gluteal muscles of the buttocks, the vastus lateralis muscle of the thigh, or the deltoid muscle of the upper arm. The angle of insertion is 90 degrees. Intramuscular administration provides rapid systemic absorption and can be used for administration of relatively large doses of medication.

Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]

An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.

Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]

Amount and speed of breathed air measurement and graphic recording before and after medication administration [HCPCS 94060]

Spirometry with bronchodilation responsiveness is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. The test is first performed without administration of a bronchodilator. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. A bronchodilator medication is administered and the test is repeated. The test results are displayed on a graph that the physician reviews and interprets in a written report.

Physcial therapy exercise of walking training to 1 or more areas (each 15 minutes) [HCPCS 97116]

Gait training is a therapeutic procedure that observes and educates an individual in the manner of walking including the rhythm, cadence, step, stride, and speed. The objective of gait training is to strengthen muscles and joints, improve balance and posture, and develop muscle memory. As the lower extremities are retrained for repetitive motion, the body also benefits from the exercise with increased endurance, improved heart/lung function, and reduced or improved osteoporosis. Gait training is an appropriate therapeutic procedure following brain and/or spinal cord injury, stroke, fracture of the pelvis and/or lower extremity, joint injury or replacement of the knee, hip, or ankle, amputation, and for certain musculoskeletal and/or neurological diseases. A treadmill fitted with a safety harness is initially used to ensure safe walking. As the patient gains strength and balance, step training and stair climbing is added to the treatment modality.

Physical therapy procedure to re-educate brain-to-nerve-to-muscle function (each 15 minutes) [HCPCS 97112]

Therapeutic procedures for neuromuscular reeducation are used to develop conscious control of a single muscle or muscle group and heighten the awareness of the body's position in space, especially the position of the extremities when sitting or standing. Neuromuscular reeducation is employed during the recovery or regeneration stage following severe injury or trauma, cerebral vascular accident, or systemic neurological disease. The goal of therapy is improved range of motion (ROM), balance, coordination, posture, and spatial awareness. Techniques may include proprioceptive neuromuscular facilitation which uses diagonal contract-relax patterns of skeletal muscles to stimulate receptors in the joints that communicate body position to the brain via motor and sensory nerves. Feldenkrais is a method which observes the patient's habitual movement patterns and teaches new patterns based on efficient active or passive repetitive conditioning. Additional techniques that may be useful for neuromuscular reeducation are Bobath concept, which promotes motor learning and efficient motor control, and biomechanical ankle platform system (BAPS) boards.

CPAP (continuous positive airway pressure) mask or breathing tube initiation and management for night time respiratory muscle rest [HCPCS 94660]

Continuous positive airway pressure (CPAP) ventilation is used primarily to treat sleep apnea. It may also be prescribed to treat preterm infants whose lungs have not fully developed. CPAP uses a mask or other breathing device that fits over the nose and mouth which is connected via a tube to a CPAP device. The CPAP machine delivers an air mixture at a continuous low level of pressure. The continuous positive airway pressure keeps the airways open and prevents mechanical obstruction of the flow of air caused by relaxation and collapse of airway structures during sleep. This code is used for initial set-up and management. A durable medical device provider delivers the CPAP device and other required equipment to the home or a residential facility. The device is set up and programmed to the settings indicated by the written prescription obtained from the physician or other qualified health care professional. The patient or caregiver is instructed on correct use of the CPAP and then is asked to demonstrate understanding by placing the mask over the mouth and nose and turning on the machine.

Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]

Therapeutic exercise is the application of careful, graduated force to the body to increase strength, endurance, range of motion, and flexibility. Increased muscle strength is achieved by the deliberate overloading of a targeted muscle or muscle group and improved endurance is achieved by raising the intensity of the strengthening exercise to the targeted area(s) over a prolonged period of time. To maintain range of motion (ROM) and flexibility requires the careful movement and stretching of contractile and non-contractile tissue that may tighten with injury or neurological disease, causing weakness and/or spasticity. Therapeutic exercise can increase blood flow to the targeted area, reduce pain and inflammation, reduce the risk of blood clots from venous stasis, decrease muscle atrophy and improve coordination and motor control. Therapeutic exercise may be prescribed following acute illness or injury and for chronic conditions that affect physical activity or function.

Function improvement activities with one-on-one contact between patient and provider (each 15 minutes) [HCPCS 97530]

In a one-on-one physical therapy session, the provider instructs and assists the patient in therapeutic activities designed to address specific functional limitations. The therapeutic activities are specifically developed and modified for the patient. Dynamic/movement activities, also called kinetic activities, that are designed to improve functional performance such as lifting, bending, pushing, pulling, jumping and reaching are included in this service. For example, the patient may be given therapeutic activities to perform to improve the ability to sit, stand, and get out of bed after an injury without straining or risking reinjury. This code is reported for each 15 minutes of one-on-one therapeutic activity provided.

Training activities for home and self-care management (each 15 minutes) [HCPCS 97535]

Self-care/home managemeThe patient receives one-on-one training to improve the ability to care for himself/herself and maintain independence. This may include training in activities of daily living (ADL), such as bed mobility, transfers, dressing, grooming, eating, bathing and toileting. The patient is given instruction on compensatory measures that can be taken to overcome any physical, mental or emotional disabilities. The patient receives training in how to adapt meal preparation to his/her specific needs and how to perform activities safely. The patient may also receive instruction in the use of assistive technology devices and adaptive equipment which includes any item used to improve the functional capability of the patient in the home and with ADL. This code is reported for each 15 minutes of one-on-one self-care/home management training designed to meet the specific needs of the patient.nt training, which includes instructions in the use of any assisting equipment.

Speech, language, voice, communication, and/or hearing processing disorder treatment [HCPCS 92507]

A speech-language pathologist treats a speech, language, voice, communication, and/or auditory processing disorder. Using the information obtained from a separately reportable screening and in-depth evaluation of a speech or language disorder, the clinician develops an individualized treatment plan for the patient. The clinician defines specific treatment goals and sets baseline measures with which to assess the patient's progress. These goals are continuously monitored and fine-tuned throughout the treatment period. Once the goals and baseline measures have been established the clinician uses a number of intervention activities to correct the specific speech or language disorder identified. These can include games, stories, rhymes, drills, and other tasks. If the patient has a speech disorder, the clinician may demonstrate the sounds and have the patient copy the way the clinician moves the lips, mouth, and tongue to make the right sound. A mirror may be used so that the patient can practice making the sound while observing himself or herself in the mirror. Treatment of a language disorder might include help with grammar. If the patient is having difficulty with auditory processing, a game like Simon Says might be used to help improve understanding of verbal instructions.

Swallowing and/or oral feeding function treatment [HCPCS 92526]

Swallowing dysfunction and/or oral function are treated in an individual with difficulty passing food or liquid from the mouth or throat into the stomach. A swallowing or oral function disorder can occur in any age group or at any point in the swallowing process as food or liquid passes from the mouth, through the pharynx and esophagus, into the stomach. Swallowing disorders are common in individuals with degenerative neurological disorders such as cerebral palsy, amyotrophic lateral sclerosis (ALS), postpolio syndrome, myasthenia gravis, multiple sclerosis, and Parkinson's disease. A swallowing disorder may also result from neurological damage such as a stroke or head or spinal cord injury, or from a congenital or acquired deformity of the mouth, pharynx, esophagus, or stomach. Medical treatment is provided for a patient with a swallowing or oral function disorder. The diet is modified. Swallowing posture is assessed and modified as needed. Swallowing technique is modified to strengthen oropharyngeal muscle groups and improve the mechanics of swallowing so that food and liquid can pass into the esophagus and then into the stomach without aspiration into the lungs.

Blood flow (outside of the brain) ultrasound on both sides of head and neck [HCPCS 93880]

A vascular ultrasound study is performed to evaluate the extracranial arteries which include the common carotid and external carotid arteries. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin over the arteries to be studied. A B-mode transducer is placed on the skin and real-time images of the artery are obtained. A Doppler probe within the B-mode transducer provides information on pattern and direction of blood flow in the artery. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the arteries when the probe is placed over the arteries at various locations and angles. The Doppler probe produces sound waves that bounce off blood cells moving within the artery. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function, including information on the presence of narrowing and plaque formation within the arteries. The physician reviews the duplex scan and provides a written interpretation of findings.

Heart ultrasound including color-depicted blood flow rate, direction, and valve function [HCPCS 93306]

The physician performs complete transthoracic real-time echocardiography with image documentation (2-D) including M-mode recording, if performed, with spectral Doppler and color flow Doppler echocardiography. Cardiac structure and dynamics are evaluated using a series of real-time tomographic images with multiple views recorded digitally or on videotape. Time-motion (M-mode) recordings are made as needed to allow dimensional measurement. Blood flow and velocity patterns within the heart, across valves and within the great vessels are evaluated by color flow Doppler. Normal blood flow patterns through these regions have a characteristic pattern defined by direction, velocity, duration, and timing throughout the cardiac cycle. Spectral Doppler by pulsed or continuous wave technique is used to evaluate antegrade flow through inflow and outflow tracts and cardiac valves. Multiple transducer positions or orientations may be required. The physician reviews the echocardiography images and orders additional images as needed to allow evaluation of any abnormalities. Digital or videotaped images are then reviewed by the physician. Abnormalities of cardiac structure or dynamics are noted. The extent of the abnormalities is evaluated and quantified. Any previous cardiac studies are compared to the current study and any quantitative or qualitative changes are identified. The physician provides an interpretation of the echocardiography with a written report of findings.

Arteries of both arms and legs ultrasound (limited) [HCPCS 93922]

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (complete, both arms or legs) [HCPCS 93970]

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (limited, one arm or leg) [HCPCS 93971]

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Imaging of arm joint by MRI without contrast [HCPCS 73221]

Magnetic resonance imaging is done on a joint of the upper or lower arm. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the upper extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT.

Ultrasound of area behind abdominal cavity (complete) [HCPCS 76770]

A real time retroperitoneal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained of the retroperitoneal area. The ultrasonic wave pulses directed at the retroperitoneum are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the retroperitoneum and provides a written interpretation.

Imaging of arm by MRI without contrast [HCPCS 73218]

Magnetic resonance imaging is done on the upper or lower arm, other than a joint. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the arm. MRI scans of the arm are often done for injury, trauma, or unexplained pain and provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms. MRI provides reliable information for diagnosing tendinitis; muscle atrophy and other anomalous muscular development; lesions of soft tissue and bone; osteomyelitis; contusions, hematomas, and other masses that can be palpated on exam; and broken bones or other abnormal findings on x-ray or bone scan.

Abdominal ultrasound (complete) [HCPCS 76700]

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

Imaging of brain by MRI without contrast [HCPCS 70551]

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

Imaging of leg joint by MRI without contrast [HCPCS 73721]

Magnetic resonance imaging is done on a joint of the upper or lower leg. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the lower extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms. MRI provides reliable information on the presence and extent of tumors, masses, or lesions within the joint; infection, inflammation, and swelling of soft tissue; muscle atrophy and other anomalous muscular development; and joint effusion and vascular necrosis.

Arm or leg ultrasound (complete) [HCPCS 76881]

Ultrasound, also referred to as sonography and echography, is a non-invasive imaging technique that uses high-frequency sound waves to evaluate tissues and structures. Nonvascular structures of the extremities that may be evaluated by ultrasound include periarticular soft tissue masses, muscles, tendons, nerves, ligaments, and joints. Common conditions that can be detected or evaluated by ultrasound include cystic lesions, solid tumors, abscesses, joint effusion, tendon tears, tendonitis, tenosynovitis, nerve compression, and stress fractures. Acoustic coupling gel is applied to the extremity to be examined. An ultrasound probe is placed against the skin and moved over the target joint area to be examined as sound waves pass through and bounce off extremity tissues and structures. The sound waves are reflected back to the receiving unit at varying speeds and converted into images. Longitudinal, transverse, and oblique images are obtained. The physician reviews the images and provides a written interpretation.

Imaging of leg by MRI without contrast [HCPCS 73718]

Magnetic resonance imaging is done on the upper or lower leg, other than a joint. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the leg. MRI scans of the leg are often done for injury, trauma, or unexplained pain and provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms. MRI provides reliable information for diagnosing tendinitis; muscle atrophy and other anomalous muscular development; lesions of soft tissue and bone; osteomyelitis; contusions, hematomas, and other masses that can be palpated on exam; and broken bones or other abnormal findings on x-ray or bone scan.

Imaging of lower spinal canal by MRI without contrast, followed by contrast [HCPCS 72158]

Magnetic resonance imaging (MRI) is done on the cervical, thoracic, or lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery. Images are taken first without contrast and again after the administration of contrast to see the spinal area better. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]

Magnetic resonance imaging (MRI) is done on the lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back pain is unsuccessful and more aggressive treatments are considered or following surgery. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

Imaging of middle spinal canal by MRI without contrast [HCPCS 72146]

Magnetic resonance imaging (MRI) is done on the thoracic spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

Pelvis ultrasound, not pregrnancy related (complete) [HCPCS 76856]

A real time pelvic (non-obstetric) ultrasound is performed with image documentation to evaluate the uterus and cervix, ovaries, fallopian tubes, and bladder. Conditions evaluated include pelvic pain, abnormal bleeding, and palpable masses, such as ovarian cysts, uterine fibroids, or other pelvic masses. The patient presents with a full bladder. Acoustic coupling gel is applied to the skin of the lower abdomen. The transducer is pressed firmly against the skin and swept back and forth over the lower abdomen and images obtained of the uterus, ovaries, and surrounding pelvic structures. The ultrasonic wave pulses directed at the pelvic structures are imaged by recording the ultrasound echoes. Any abnormalities are evaluated. The physician reviews the ultrasound images and provides a written interpretation.

Imaging of upper spinal canal by MRI without contrast [HCPCS 72141]

Magnetic resonance imaging (MRI) is done on the cervical spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the head or brain is performed. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Imaging of heart vessels with SPECT tomography and drugs or exercise (multiple studies) [HCPCS 78452]

Myocardial perfusion imaging is a nuclear medicine procedure used to evaluate the heart muscle and blood flow to the heart. An intravenous line is inserted into a vein in the hand or arm. ECG leads are placed and a blood pressure cuff is placed on the arm. The patient lies flat on a table in the procedure room for myocardial perfusion imaging performed at rest. For a stress study, the patient is either on a treadmill or bike or an injection of a pharmacologic agent is administered to stress the heart. A radionuclide, also called a tracer, is injected into the intravenous line and allowed to circulate. The radionuclide localizes in healthy heart tissue. Ischemic heart tissue does not absorb the radionuclide. Images of the heart and great vessels are obtained using single photon emission computed tomography (SPECT). When SPECT images are obtained, the scanner rotates around the body to obtain images in multiple planes. The physician evaluates heart wall motion to determine how effective the heart muscle is in pumping blood through the heart and to the peripheral vascular system. Ejection fraction, which is the percentage of blood pumped out of the heart to the peripheral vascular system, is measured using either a first pass or gated technique. In a first pass technique, images are obtained as the blood circulates through the heart during the first pass of the radionuclide. In a gated technique, a series of images are obtained between heart beats. Using electrical signals from the heart, the camera captures a series of images as the heart rests, creating very sharp, high resolution images. Additional images are obtained as needed. The physician reviews the images, calculates the ejection fraction and quantifies other parameters of heart function based on the distribution of the radionuclide. The physician then provides a written report of findings.

Abdominal and pelvic CT scan without contrast, followed by contrast for injury, foreign bodies, or tumors [HCPCS 74178]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

Liver and bile duct system imaging with the use of oral medication [HCPCS 78227]

Hepatobiliary system nuclear imaging tracks the production and flow of bile from the liver to the small intestine using a radioactive tracer that highlights the liver, bile ducts, and gallbladder if the gallbladder has not been surgically removed. This procedure may also be referred to as a HIDA scan which stands for hepatobiliary iminodiacetic acid scan. The procedure is performed to evaluate liver function, specifically bile production and excretion, and to evaluate the drainage system (bile ducts) and gallbladder for obstruction, inflammation, or other abnormalities. An intravenous catheter is placed. The radioactive tracer is injected. A gamma camera travels back and forth over the abdomen and multiple images are obtained as the radioactive tracer flows through the bloodstream and is taken up by the bile-producing cells in the liver. Images are obtained continuously as the radioactive tracer, which is now contained in the bile, travels from the liver through the biliary ducts into the gallbladder, and then from the gallbladder through the common bile duct into the duodenum. The patient is monitored throughout the procedure. Upon completion, the physician reviews the images and provides a written report of findings. The procedure is performed as described above except that during the procedure additional medications are administered. These medications may be given to enhance the gallbladder images or to trigger the gallbladder to empty. The physician may also perform a test called gallbladder ejection fraction which is a measurement of the rate at which bile is released from the gallbladder.

Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

Abdominal and pelvic CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 74176]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

Arm CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 73200]

Diagnostic computed tomography (CT) is done on the upper extremity to provide detailed visualization of the tissues and bone structure of the arm. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the arm can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the upper extremity. The physician reviews the CT scan, notes any abnormalities, and provides a written interpretation of the findings. The physician reviews the images to look for suspected problems with the arm such as locating tumors, abscesses, or masses; evaluating the bones for degenerative conditions, fractures, or other injury following trauma; and finding the cause of pain or swelling.

Abdominal and pelvic vessels CTA scan with contrast [HCPCS 74174]

Computed tomographic angiography (CTA) provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images of the abdomen and pelvis are obtained as needed. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA of the abdomen and pelvis is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the blood vessels of the abdomen and pelvis.

Mammography of both breasts (screening exam) [HCPCS 77067]

Bilateral screening mammography is done with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength than those typically used for bone imaging. A screening mammogram is done on asymptomatic women for early breast cancer detection when there are no known palpable masses. This is done on both breasts with two views taken on each side. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Ultrasound guidance for needle placement including imaging supervision of procedure and interpretation of results [HCPCS 76942]

Ultrasound guidance including imaging supervision and interpretation is performed for needle placement during a separately reportable biopsy, aspiration, injection, or placement of a localization device. A local anesthetic is injected at the site of the planned needle or localization device placement. A transducer is then used to locate the lesion, site of the planned injection, or site of the planned placement of the localization device. The radiologist constantly monitors needle placement with the ultrasound probe to ensure the needle is properly placed. The radiologist also uses ultrasound imaging to monitor separately reportable biopsy, aspiration, injection, or device localization procedures. Upon completion of the procedure, the needle is withdrawn and pressure applied to control bleeding. A dressing is applied as needed. The radiologist then provides a written report of the ultrasound imaging component of the procedure.

Head and neck ultrasound [HCPCS 76536]

An ultrasound examination of soft tissues of the head and neck is performed with image documentation. The thyroid, parathyroid, or parotid glands and surrounding soft tissue may be examined. Ultrasound visualizes the body internally using sound waves far above human perception bounce off interior anatomical structures. As the sound waves pass through different densities of tissue, they are reflected back to the receiving unit at varying speeds and converted into pictures displayed on screen. A linear scanner or mechanical sector scanner is used to evaluate the shape, size, border, internal architecture, distal enhancement, color flow, and echogenicity of the soft tissue structures of the head and neck as well as any lesions or masses. The echogenicity is compared to that of the surrounding muscle tissue. The physician reviews the images and provides a written interpretation.

CTA scan of chest blood vessels with contrast to examine injury, foreign bodies, or tumors [HCPCS 71275]

A computed tomographic angiography (CTA) of the noncoronary vessels of the chest is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the noncoronary vessels of the chest.

Imaging of scrotum by ultrasound [HCPCS 76870]

An ultrasound examination of the scrotum and its contents is a non-invasive procedure that uses a transducer probe placed firmly against the skin to deliver high frequency sound waves and create a gray scale and/or color (Doppler) image of the internal anatomy. Ultrasound may be used to detect scrotal masses/tumors and undescended testicle(s), as well as to evaluate testicular torsion, scrotal injury or trauma, hydrocele(s), varicocele(s), and male infertility. Ultrasonic conduction gel is applied to the scrotum and the transducer probe is held against the skin and swept over the area. The images produced are captured on a screen and viewed in real-time and/or saved for later analysis.

Abdominal x-ray (single view) [HCPCS 74018]

A radiologic examination of the abdomen images the internal organs, soft tissue (muscle, fat), and supporting skeleton. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the x-rays to be absorbed and some to pass through and be captured. This produces a 2D image of the structures. The radiographs may be taken to look for size, shape, and position of organs, pattern of air (bowel gas), obstruction, foreign objects, and calcification in the gallbladder, urinary tract, and aorta. A radiologic examination of the abdomen may be ordered to diagnose abdominal distention and pain, vomiting, diarrhea or constipation, and traumatic injury; it may also be obtained as a screening exam or scout film prior to other imagining procedures. Common views of the abdomen include front to back anteroposterior (AP) with the patient lying supine or standing erect, back to front posteroanterior (PA) with the patient lying prone, lateral with the patient lying on the side, lateral decubitus anteroposterior (side lying, front to back view), lateral dorsal decubitus (lying supine, side view), oblique (anterior or posterior rotation), and coned (small collimated) views which may be used to localize and differentiate lesions, calcifications, or herniations.

Abdominal x-ray (2 views) [HCPCS 74019]

A radiologic examination of the abdomen images the internal organs, soft tissue (muscle, fat), and supporting skeleton. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the x-rays to be absorbed and some to pass through and be captured. This produces a 2D image of the structures. The radiographs may be taken to look for size, shape, and position of organs, pattern of air (bowel gas), obstruction, foreign objects, and calcification in the gallbladder, urinary tract, and aorta. A radiologic examination of the abdomen may be ordered to diagnose abdominal distention and pain, vomiting, diarrhea or constipation, and traumatic injury; it may also be obtained as a screening exam or scout film prior to other imagining procedures. Common views of the abdomen include front to back anteroposterior (AP) with the patient lying supine or standing erect, back to front posteroanterior (PA) with the patient lying prone, lateral with the patient lying on the side, lateral decubitus anteroposterior (side lying, front to back view), lateral dorsal decubitus (lying supine, side view), oblique (anterior or posterior rotation), and coned (small collimated) views which may be used to localize and differentiate lesions, calcifications, or herniations.

Ankle x-ray (minimum of 3 views) [HCPCS 73610]

A radiologic examination of the ankle images the bones of the distal lower extremities including the tibia, fibula, and talus. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Ankle x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the ankle include front to back anteroposterior (AP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

CTA scan of head blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70496]

A computed tomographic angiography (CTA) of the head is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the head.

Hip x-ray of both hips with pelvis (2 views) [HCPCS 73521]

A radiologic examination is done on both the left and the right hip, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table. A front to back view of the hips in a pelvic view is often taken with the patient supine and both legs rotated slightly inward about 15 degrees.

CTA scan of neck blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70498]

A computed tomographic angiography (CTA) of the neck is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the neck.

Chest CT scan without contrast, followed by contrast to examine injury, foreign bodies, or tumors [HCPCS 71270]

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

Chest CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 71260]

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

Chest CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 71250]

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

Chest x-ray (single view) [HCPCS 71045]

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Skull CT scan to examine the bones of the eye and ear without contrast to examine injury, foreign bodies, or tumors [HCPCS 70480]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the eye socket (orbit); region that houses the pituitary gland (sella); region at the base of the skull (posterior fossa); or any portion of the ear (outer, middle, or inner) is obtained. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest. The physician reviews the CT scan, notes any abnormalities, and provides a written interpretation of the findings.

Chest x-ray (2 views) [HCPCS 71046]

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Elbow x-ray, complete study (minimum of 3 views) [HCPCS 73080]

A radiologic examination of the elbow is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays of the elbow are usually considered necessary to assess for fractures or dislocations when the normal range of motion for extension, flexion, supination, and pronation cannot be carried out. Most acute disruptions of the elbow joint can be diagnosed by conventional x-ray examination, with the minimum number of views including the front to back anteroposterior projection with the elbow in as full extension as possible, and the side, or lateral image taken in flexion. A complete series of images also includes an oblique view of the radial head-capitellar image to help diagnose suspected subtle fractures involving the radial head or in cases of acute pain and trauma. The patient needs to be able to hold the elbow in full extension for the front view and in 90 degree flexion for the oblique and lateral views as much as possible.

Finger(s) x-ray (minimum of 2 views) [HCPCS 73140]

A radiologic examination of the finger(s) is done with at least 2 different projections taken. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, interphalangeal (IP) joint dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, or tumors. The posteroanterior projection is taken with the palm down flat, fingers extended, and slightly apart to show the metacarpals, phalanges, and IP joints of the target finger(s). Anteroposterior views are taken with the back of the hand placed on the film and the x-ray beam going from palmar to dorsal direction. Lateral views are taken with the ulnar side of the hand on the film cassette and the fingers spread apart to avoid overlap, sometimes supported from underneath. Oblique views can be obtained with the hand placed palm down and the radial side rotated 45 degrees up away from the surface, with the fingers extended and spread apart.

Facial CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70486]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the maxillofacial area is obtained. The maxillofacial area includes the forehead (frontal bone), sinuses, nose and nasal bones, jaw (maxilla and mandible). The only facial region not included in this study is the orbit. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Foot x-ray, complete study (minimum of 3 views) [HCPCS 73630]

A radiologic examination of the foot images the bones of the distal lower extremity and may include the tibia, fibula, talus, calcaneus, cuboid, navicular, cuneiform, metatarsals, and phalanges. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Foot x-rays may also be used to determine whether there is satisfactory alignment of foot bones following fracture treatment. Standard views of the foot include top to bottom dorsal planter (DP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

Leg CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 73700]

Diagnostic computed tomography (CT) is done on the lower extremity to provide detailed visualization of the tissues and bone structure of the leg. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the leg can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the lower extremity.

Arm x-ray of forearm (2 views) [HCPCS 73090]

A radiologic examination of the forearm is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Frontal views, or back to front (PA) views and lateral views are necessary to show the radius and ulna and assess the extent and direction of injury. Since the radius and ulna are anatomically connected at both ends of the bones with ligaments, the two bones function in a manner that makes the forearm considered as a single unit when assessing injury. The two standard views taken for x-ray examination of the forearm include the anteroposterior (AP) view, and the lateral view.

Hand x-ray (minimum of 2 views) [HCPCS 73130]

A radiologic examination of the hand is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, or tumors. Hand x-rays are also used to help determine the 'bone age' of children and assess whether any nutritional or metabolic disorders may be interfering with proper development. The posteroanterior projection is taken with the palm down flat and may show not only the metacarpals, phalanges, and interphalangeal joints, but the carpal bones, radius, and ulna as well. Lateral views may be taken with the hand placed upright, resting upon the ulnar side of the palm and little finger with the thumb on top, ideally with the fingers supported by a sponge and splayed to avoid overlap. Oblique views can be obtained with the hand placed palm down and rolled slightly to the outside with the fingertips still touching the film surface. The beam is angled perpendicular to the cassette for oblique projections and aimed at the middle finger metacarpophalangeal joint.

Foot x-ray at heel of foot (minimum of 2 views) [HCPCS 73650]

A radiologic examination of the calcaneus images the bones of the distal lower extremity and usually includes the tibia, fibula, and talus. A radiologic examination of the toe(s) (phalanges) will usually include the metatarsals. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Calcaneus and toe(s) x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views to image the calcaneus include lateral (side) and axial (supine with foot dorsiflexed). Common views to image the toe(s) include top to bottom dorsal planter (DP) and oblique (supine with leg rotated medially to image the 1st, 2nd, and 3rd digits and laterally to image the 4th and 5th digits).

Spinal CT scan of lower spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72131]

Diagnostic computed tomography (CT) is done on the lumbar spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the lumbar spine. The physician reviews the images to look for suspected problems with the spine such as bone disease, and evaluate for fractures or other injuries as well as birth defects of the spine in children.

Spinal CT scan of middle spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72128]

Diagnostic computed tomography (CT) is done on the thoracic spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the thoracic spine. The physician reviews the images to look for suspected problems with the spine such as bone disease, and evaluate for fractures or other injuries as well as birth defects of the spine in children.

Pelvis CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 72192]

Diagnostic computed tomography (CT) is done on the pelvis to provide detailed visualization of the organs and structures within or near the pelvis, such as kidneys, bladder, prostate, uterus, cervix, vagina, lymph nodes, and pelvic bones. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of organs within the pelvis can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the pelvis area. The physician reviews the images to gather information for specified purposes such as diagnosing or monitoring cancer, evaluating the pelvic bones for fractures or other injury following trauma, locating abscesses or masses found during physical exam, finding the cause of pelvic pain, providing more detailed information before surgery, and evaluating the patient after surgery.

Hip x-ray of hip with pelvis (2 to 3 views) [HCPCS 73502]

A radiologic examination of the hip is done on either the left or the right side, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table.

Neck CT scan of the soft tissue of the neck with contrast to examine injury, foreign bodies, or tumors [HCPCS 70491]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In a CT scan of the soft tissues of the neck, the patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Knee x-ray (1 or 2 views) [HCPCS 73560]

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

Neck CT scan of the soft tissue of the neck without contrast to examine injury, foreign bodies, or tumors [HCPCS 70490]

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In a CT scan of the soft tissues of the neck, the patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

Knee x-ray (4 or more views) [HCPCS 73564]

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

Spinal CT scan of upper spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72125]

Diagnostic computed tomography (CT) is done on the cervical spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the cervical spine.

Spinal x-ray of lower and sacral spine (2 or 3 views) [HCPCS 72100]

A radiologic exam is done of the lumbosacral spine. Frontal, posteroanterior, and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]

A radiologic exam is done of the lumbosacral spine. Frontal, posteroanterior, and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Mammography of one breast for diagnosis [HCPCS 77065]

These codes report diagnostic mammography of one breast or both breasts with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength that those typically used for bone imaging. The test is done to detect tumors or cysts in women who have symptoms of breast disease or a palpable mass. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Mammography of both breasts for diagnosis [HCPCS 77066]

These codes report diagnostic mammography of one breast or both breasts with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength that those typically used for bone imaging. The test is done to detect tumors or cysts in women who have symptoms of breast disease or a palpable mass. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Lower leg x-ray (2 views) [HCPCS 73590]

A radiologic examination of the tibia and fibula images the bones of the distal lower extremities and may include the knee and ankle joints. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Tibia and fibula x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the tibia and fibula include front to back anteroposterior (AP) and lateral (side).

Spinal x-ray of middle spine (2 views) [HCPCS 72070]

A radiologic exam is done of the thoracic spine. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays are taken of the thoracic spine to evaluate for back pain or suspected disease or injury. Films are taken from differing views that commonly include anteroposterior, lateral, posteroanterior, and a swimmer's view for the upper thoracic spine in which the patient reaches up with one arm and down with the other as if taking a swimming stroke.

Pelvis x-ray (1 or 2 views) [HCPCS 72170]

A diagnostic x-ray examination of the pelvis is done. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Bones appear white while soft tissue and fluids appear shades of grey. Pelvic x-rays are taken when the patient complains of pain and/or injury in the area of the pelvis or hip joints to assess for fractures and detect arthritis or bone disease. The patient is placed on a table and different views of the pelvis are taken by having the patient position the legs and feet differently, such as turning the feet inward to point at each other, or bending the knees outward with the soles of the feet together in a 'frog-leg' position.

Imaging for swallowing function evaluation with contrast [HCPCS 74230]

A radiologic study with cineradiography/videoradiography may be performed to assess swallowing function in patients with dysphagia. A swallowing function study (modified barium swallow, MBS) may be indicated for patients with a history of stroke or other central nervous system (CNS) disorders, surgery or radiation to the head/neck, neuromuscular or rheumatologic disease, generalized debilitation and  head/neck/throat injury including peripheral nerve injury. The patient is seated upright or semi-reclining with the fluoroscopy machine focused on the head and neck. Food and liquids of various texture and quantity are mixed or soaked in contrast medium (barium) and administered to the patient. A fluoroscopic recording is made of the food or fluid in the oral cavity, larynx, pharynx, and upper esophagus to document mastication and tongue mobility, elevation and retraction of the velum, tongue base retraction and movement of the hyoid bone and larynx, closure of the larynx, contraction of the pharynx, and the duration and extent of pharyngoesophageal segment opening. Observation and recording is made of any penetration or aspiration of food and fluid into the upper airways. The measurement of muscle sensation and strength may be inferred or calculated directly from the information obtained during the study.

Fluoroscopy imaging guidance for procedure (up to 1 hour) [HCPCS 76000]

Breast ultrasound (one breast, limited) [HCPCS 76642]

A real time ultrasound of the right or left breast is performed with image documentation, including the axillary area, when performed. Breast ultrasound is used to help diagnose breast abnormalities detected during a physical exam or on mammography. Ultrasound imaging can identify masses as solid or fluid-filled and can show additional structural features of the abnormal area and surrounding tissues. The patient is placed supine with the arm raised above the head on the side being examined. Acoustic coupling gel is applied to the breast and the transducer is pressed firmly against the skin of the breast. The transducer is then swept back and forth over the area of the abnormality and images are obtained. The ultrasonic wave pulses directed at the breast are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the breast and provides a written interpretation.

Rib cage x-ray of ribs on one side of body (2 views) [HCPCS 71100]

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

Abdominal ultrasound (limited) [HCPCS 76705]

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Rib cage x-ray of ribs on one side of body including chest (minimum of 3 views) [HCPCS 71101]

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

Imaging of abdomen by MRI without contrast, followed by contrast [HCPCS 74183]

Magnetic resonance imaging is done on the abdomen. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the abdomen. MRI is often done for trauma and suspected internal injury, and unexplained abdominal pain, swelling, and fever. MRI scans provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms, such as the location of tumors, abscesses, or masses; the presence of kidney stones, hernias, appendicitis or other infections, and internal injury.

Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]

A radiologic examination of the shoulder is done. The shoulder is the junction of the humeral head and the glenoid of the scapula. Standard views include the anteroposterior (AP) view and the lateral 'Y' view, named because of the Y shape formed by the scapula when looking at it from the side. An axial view can also be obtained for further assessment when the patient is able to hold the arm in abduction. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Neck x-ray to examine soft tissue for any obstructions and/or foreign bodies within the throat or neck [HCPCS 70360]

X-rays are taken to evaluate the soft tissue of the neck. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Frontal and lateral views of the neck may be taken for better evaluation. The physician reviews the radiographs to determine any asymmetry or enlargement on one side or the other, the caliber and contour of the trachea, and any soft tissue swelling that may involve the adenoids, tonsils, epiglottis, or aryepiglottic folds.

Thighbone x-ray (minimum of 2 views) [HCPCS 73552]

A radiologic examination of the femur is done between the hip and the knee. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, and cysts or tumors. X-rays may also be used to determine whether the femur is in satisfactory alignment following fracture treatment. Femur standard views that are taken most frequently include the front to back anteroposterior view and the lateral view from the side.

Toe(s) x-ray (minimum of 2 views) [HCPCS 73660]

A radiologic examination of the calcaneus images the bones of the distal lower extremity and usually includes the tibia, fibula, and talus. A radiologic examination of the toe(s) (phalanges) will usually include the metatarsals. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Calcaneus and toe(s) x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views to image the calcaneus include lateral (side) and axial (supine with foot dorsiflexed). Common views to image the toe(s) include top to bottom dorsal planter (DP) and oblique (supine with leg rotated medially to image the 1st, 2nd, and 3rd digits and laterally to image the 4th and 5th digits).

Arm x-ray of upper arm (minimum of 2 views) [HCPCS 73060]

A radiologic examination of the humerus is done with a minimum of 2 views taken. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The surgical neck of the humerus is the most common site of fracture. Shaft fractures are often associated with some kind of pathological lesion. X-rays of the humerus can be taken to detect deformities or lesions in the upper arm, such as cysts, tumors, late stage infection, or other diseases as well as a broken bone. The standard views of the humerus include the front to back anteroposterior view and the side, or lateral view.

Spinal x-ray of upper spine (2 or 3 views) [HCPCS 72040]

A radiologic exam is done of the cervical spine. Anteroposterior and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Spinal x-ray of upper spine (4 or 5 views) [HCPCS 72050]

A radiologic exam is done of the cervical spine. Anteroposterior and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

Wrist x-ray, complete study (minimum of 3 views) [HCPCS 73110]

A radiologic examination of the wrist is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, arthritis, foreign body, infection, or tumor. Wrist standard views include the front to back anteroposterior (AP) or back to front posteroanterior (PA) projection; the lateral view with the elbow flexed and the hand and wrist placed thumb up; and oblique views. Oblique views are obtained with the hand and wrist either supinated or pronated with the hand slightly flexed so the carpal target area lies flat, and then rotating the wrist 45 degrees externally or internally. A more specialized image may be obtained for assessing carpal tunnel. For the carpal tunnel view, the forearm is pronated with the palm down, and the wrist is hyperextended as far as possible by grasping the fingers with the opposite hand and gently hyperextending the joint until the metacarpals and fingers are in a near vertical position.

Abdominal x-ray, complete study including 2 or more views of abdomen and single view of chest [HCPCS 74022]

A radiologic examination of the abdomen images the internal organs, soft tissue (muscle, fat), and supporting skeleton. X-ray imaging uses indirect ionizing radiation to take pictures of non-uniform material, such as human tissue, because of its different density and composition, which allows some of the x-rays to be absorbed and some to pass through and be captured. This produces a 2D image of the structures. The radiographs may be taken to look for size, shape, and position of organs, pattern of air (bowel gas), obstruction, foreign objects, and calcification in the gallbladder, urinary tract, and aorta. A radiologic examination of the abdomen may be ordered to diagnose abdominal distention and pain, vomiting, diarrhea or constipation, and traumatic injury; it may also be obtained as a screening exam or scout film prior to other imagining procedures.

Total Knee or Hip Replacement

Pneumonia with complications

Kidney & urinary Infection without complications

Vancomycin hcl injection [HCPCS J3370]

Injection, vancomycin hcl, 500 mg

Vitamin k phytonadione inj [HCPCS J3430]

Cefazolin sodium injection [HCPCS J0690]

Injection, cefazolin sodium, 500 mg

Ceftriaxone sodium injection [HCPCS J0696]

Injection, ceftriaxone sodium, per 250 mg

Denosumab injection [HCPCS J0897]

Hydromorphone injection [HCPCS J1170]

Injection, hydromorphone, up to 4 mg

Ertapenem injection [HCPCS J1335]

Inj enoxaparin sodium [HCPCS J1650]

Injection, enoxaparin sodium, 10 mg

Insulin injection [HCPCS J1815]

Ketorolac tromethamine inj [HCPCS J1885]

Injection, ketorolac tromethamine, per 15 mg

Levofloxacin injection [HCPCS J1956]

Injection, levofloxacin, 250 mg

Lorazepam injection [HCPCS J2060]

Injection, lorazepam, 2 mg

Meperidine hydrochl /100 mg [HCPCS J2175]

Meropenem [HCPCS J2185]

Inj midazolam hydrochloride [HCPCS J2250]

Injection, midazolam hydrochloride, per 1 mg

Morphine sulfate injection [HCPCS J2270]

Injection, morphine sulfate, up to 10 mg

Ondansetron hcl injection [HCPCS J2405]

Injection, ondansetron hydrochloride, per 1 mg

Promethazine hcl injection [HCPCS J2550]

Injection, promethazine hcl, up to 50 mg

Regadenoson injection [HCPCS J2785]

Fentanyl citrate injection [HCPCS J3010]

Injection, fentanyl citrate, 0.1 mg

Triamcinolone acet inj nos [HCPCS J3301]

Diazepam injection [HCPCS J3360]

Rbc leukocytes reduced [HCPCS P9016]

Red blood cells, leukocytes reduced, each unit

Vein wound compression system application to lower leg below knee including ankle and foot [HCPCS 29581]

Collection of blood specimen from arterial puncture for diagnosis [HCPCS 36600]

The radial artery is the most common site for arterial puncture with alternative sites being the axillary and femoral arteries. The arterial puncture site is selected. The skin is prepped for sterile entry. The selected artery is punctured and the necessary blood samples obtained for separately reportable laboratory studies. The needle is withdrawn and pressure applied to the puncture site.

Large joint or joint capsule fluid removal and/or injection with needle [HCPCS 20610]

Arthrocentesis, aspiration, and/or injection of a joint or bursa is performed. Arthrocentesis and aspiration is performed to remove fluid from a joint or bursa in order to diagnose the cause of joint effusion and/or to reduce pain caused by the excess fluid. Injection of a joint or bursa may be performed in conjunction with the arthrocentesis procedure and is typically performed using an anti-inflammatory medication such as a steroid to reduce inflammation of the joint or bursa. The skin over the joint is cleansed. A local anesthetic is injected as needed. A needle with a syringe attached is inserted into the affected joint or bursa. Fluid is removed and sent for separately reportable laboratory analysis. This may be followed by a separate injection of medication into the joint or bursa.

Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]

An upper gastrointestinal (UGI) endoscopic examination, also referred to as an esophagogastroduodenoscopy (EGD), is performed on the esophagus, stomach, duodenum and/or jejunum with biopsy(s). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum where mucosal surfaces are inspected for any abnormalities. Single or multiple samples of suspect tissue are taken through the scope. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.

Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]

A flexible colonoscopy is performed with single or multiple biopsies. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Any suspect site(s) to be biopsied is identified and biopsy forceps are placed through the biopsy channel in the endoscope. The forceps are opened, the tissue is spiked, and the forceps are closed. The biopsied tissue is then removed through the endoscope. One or more tissue samples may be obtained and are sent for separately reportable laboratory analysis.

Prostate gland biopsy [HCPCS 55700]

Toe joint defect correction [HCPCS 28285]

Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]

Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]

A flexible colonoscopy is performed with or without collection of specimens by brushing or washing. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn as mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology (cell) samples may be obtained using a brush introduced through the endoscope. Alternatively, sterile water may be introduced to wash the mucosal lining and the fluid aspirated to obtain cell samples. Cytology samples are sent for separately reportable laboratory analysis.

Breathing tube insertion into windpipe cartilage with endoscope (emergent) [HCPCS 31500]

The mouth is opened and any dentures are removed. A laryngoscope is passed into the hypopharynx and the glottis and vocal cords are visualized. A properly sized endotracheal tube is selected and the balloon is inflated. A stylet is inserted into the endotracheal tube and the tube and stylet are bent into a crescent shape. The endotracheal tube and stylet are inserted alongside the laryngoscope into the trachea and positioned with the balloon lying just beyond the vocal cords. The stylet is removed and the endotracheal tube is connected to the ventilation device and secured with tape. Breath sounds are checked using a stethoscope to ensure that the endotracheal tube is properly positioned.

Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]

Esophagus, stomach, and/or upper small bowel examination and guide wire insertion for widening with endoscope [HCPCS 43248]

Needle insertion into vein for collection of blood sample [HCPCS 36415]

An appropriate vein is selected, usually one of the larger anecubital veins such as the median cubital, basilic, or cehalic veins. A tourniquet is placed above the planned puncture site. The site is disinfected with an alcohol pad. A needle is attached to a hub and the vein is punctured. A Vacuainer tube is attached to the hub and the blood specimen is collected. The Vacutainer tube is removed. Depending on the specific blood tests required, multiple Vacutainers may be filled from the same punchture site.

Median nerve of hand release and/or relocation (Carpal Tunnel Release) [HCPCS 64721]

Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]

Gallbladder removal with x-ray study of bile ducts with endoscope [HCPCS 47563]

Knee cartilage removal with endoscope (one knee) [HCPCS 29881]

Knee joint repair at lower or upper part of joint (inside and outside compartments) [HCPCS 27447]

Simple control of nose bleed (limited cautery and/or packing) [HCPCS 30901]

Nasal hemorrhage is also referred to as epistaxis. The most common sites of bleeding are the anterior portion of the nasal septum at the plexus of vessels known as the Kiesselbach's plexus or the ethmoidal vessels also located in the anterior region of the nasal cavity. Less common is bleeding from the sphenopalatine artery located posteriorly. Pledgets soaked in an anesthetic-vasconstrictor solution are inserted into the nasal cavity for 10-15 minutes to anesthetize and shrink the nasal mucosa. Following removal of the pledgets, the nasal cavity is examined. If the bleeding point can be identified, bleeding is controlled with pressure followed by chemical cautery using a silver nitrate stick applied to the bleeding point. Alternatively, electrocautery may be used. If pressure and electrocautery or chemical cautery fails, Vaseline gauze packing, a nasal tampon or sponge, or an epistaxis balloon may be used.

Indwelling bladder catheter insertion (simple) [HCPCS 51702]

A temporary indwelling catheter is inserted into the bladder. This may be referred to as Foley catheterization. A catheter kit is prepared. The urethra is cleansed with antiseptic solution. A sterile Foley catheter is inserted through the urethra into the bladder. The balloon is then inflated with about 10 cc of water to keep it in place. The catheter is attached to a sterile drainage bag and urine is continuously drained from the bladder.

Abscess incision and drainage (simple procedure or single abscess) [HCPCS 10060]

This skin is cleansed and local anesthetic injected as needed. A straight or elliptical incision is made spanning the entire area of fluctuance. Any pockets of pus are opened using blunt dissection. The abscess is drained and then irrigated with sterile solution.

Simple repair of wound of face, ears, eyelids, nose, lips and/or mouth (2.5 cm or less) [HCPCS 12011]

Simple repair of wound of face, ears, eyelids, nose, lips and/or mouth (2.6 to 5.0 cm) [HCPCS 12013]

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.5 cm or less) [HCPCS 12001]

Simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities is performed. The wound is cleansed and a local anesthetic is administered. The wound is inspected and determined to be superficial involving only the epidermis, dermis, or subcutaneous tissue without involvement of deeper tissues and without heavy contamination. A simple, one-layer closure using sutures, staples, or tissue adhesive is performed. Alternatively, chemical cautery or electrocautery may be used to treat the wound without closure.

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.6 to 7.5 cm) [HCPCS 12002]

Simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities is performed. The wound is cleansed and a local anesthetic is administered. The wound is inspected and determined to be superficial involving only the epidermis, dermis, or subcutaneous tissue without involvement of deeper tissues and without heavy contamination. A simple, one-layer closure using sutures, staples, or tissue adhesive is performed. Alternatively, chemical cautery or electrocautery may be used to treat the wound without closure.

Strapping application of unna boot [HCPCS 29580]

Broken lower forearm bone or growth plate separation treatment with hardware insertion (2 fragments, open treatment) [HCPCS 25608]

Tc99m sestamibi [HCPCS A9500]

Psa screening [HCPCS G0103]

Prostate cancer screening; prostate specific antigen test (psa)

Colorectal scrn; hi risk ind [HCPCS G0105]

Colorectal cancer screening; colonoscopy on individual at high risk

Colorectal cancer screening; colonoscopy on invididual not meeting high risk [HCPCS G0121]

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Hospital observation per hr [HCPCS G0378]

Hospital observation service, per hour